输尿管子宫内膜异位症33例临床分析

Analysis of 33 cases with ureteral endometriosis

目的探讨输尿管子宫内膜异位症(简称输尿管内异症)的诊断、治疗及预后。方法回顾性分析2000年1月至2013年10月北京大学第一医院诊治的33例输尿管内异症患者的临床资料。结果患者平均年龄(41.3±5.8)岁,占同期总内异症的1.1%(33/3 131)。33例患者中,6例无临床症状,27例痛经、腰腹痛及泌尿系统症状。其中输尿管内异症致左侧肾积水14例,右侧19例;输尿管下段梗阻29例,中段4例;内在型内异症9例,外在型24例。17例行肾功能检查,其中轻度损伤2例,中度3例,重度7例,无损伤5例。开腹手术18例,腹腔镜手术15例;盆腔粘连松解、输尿管病灶切除+膀胱植入、病灶切除+输尿管端端吻合和肾切除分别为10例、13例、6例和4例。术后随访25例(75.8%),中位随访时间53.4个月,1例肾积水复发。结论输尿管内异症虽发病率低,但易引起较严重后果,应重视早期诊断。手术治疗为首选,可以有效保护肾功能。

Objective To investigate the diagnosis and treatment of ureteral endometriosis. Methods We performed a retrospective study of 33 cases diagnosed as ureteral endometriosis with surgery confirmed in Peking University First Hospital from January 2000 to October 2013. Results The prevalence of ureteral endometriosis was 1.1%, with an average age of （41.3 !5.8） years. Among the 33 cases, urological symptoms and pelvic pain inclu- ding dysmenorrheal, periodic abdominal pain and osphyalgia were the main clinical characters, while there were 6 patients were asymptomatic. All patients with ureter endometriosis had hydronephrosis and hydroureter before surgery, hydronephrosis were right sided in 19 patients, left sided in 14 patients. The distal and middle sections of ureteral obstructions existed in 29 patients and 4 patients. Nine patients presented with intrinsic lesions. Laparotomy was performed in 18 patients, others were under laparoscopy surgery. Ureterolysis, ureteroureterostomy, ureteron- eocystostomy and unilateral nephrectorny were performed in 10, 13, 6 and 4 patients separately. The median follow- up time was 53.4 months with 8 cases lost. During the follow-up period, hydronephrosis recurred in 1 patient. Conclusion Because of the lack of specific symptoms, ureteral endometriosis potentially lead to serious consequences which should received additional consideration. Surgery is the best treatment for remove endometriotic lesions and relieve ureteral obstruction.